L5 Perio-Ortho interface Flashcards
What term has replaced “healthy with a reduced periodontium” when describing periodontitis patients?
Describe them as “stable”
The periodontitis diagnosis never goes away.
Any patient with Periodontitis will have more risk of attachment loss if orthodontic movement is applied as a result of a ‘reduced’ periodontium.
What are the 3 types of tooth movement?
- Physiological: overeruption or drifting of teeth following toth loss
- Pathological: heavy forces causing cell death
- Orthodontic: light, controlled forces to move teeth. Compression and tension lead to bone resorption and formation.
What type of movement is used in adult orthodontics?
Dento-alveolar movement only.
In children, ortho uses dento-alveolar movement and jaw growth.
What risks are associated with orthodontics?
- Bone loss
- Black triangles
- Gaps
- Crowding
- Gingival position and appearance affected
Pts may require expensive corrective surgery following orthodontic treatment.
Why do you think this patient has experience tooth migration and what type of tooth migration?
Pathological tooth migration
- Due to generalised perio stage 4, currently stable
- The forces acting on the teeth which have reduced the periodontium, has caused them to move
What do you think has happened to cause gingival recession in this patient?
- Non-periodontitis patient
- Periodontal complications as a result of orthodontic therapy
- Caused alveolar dehiscence, which created spacing and black triangles (interdental gingival recession)
- Aesthetic issue and possible dentine hypersensitivity
Before referring a patient for orthodontic tx, what factors should you consider with regards to their periodontal health?
- PI and BI, probing depths, mobility and furcation
- Localised or generalised recession
- Gingival overgrowth
- Other anomalies
- Risk factors e.g. diabetic, smoker
Before referring a patient for orthodontic tx, what factors should you consider with regards to their endodontic health?
- Pulpal or periapical pathology/pain
- Require management prior to ortho tx
Before referring a patient for orthodontic tx, what factors should you consider with regards to their prosthodontic health?
- Manage caries
- Pt is not suitable for ortho if they have high caries risk or xerostomia
- TSL: may need to liaise with prosthodontist, especially if there is limited tooth surface for bonding of brackets
Before referring a patient for orthodontic tx, what factors should you consider with regards to their medical history?
Medical conditions could affect bone resorption:
- Osteoporosis medication
- Rheumatoid arthritis meds
- Recent chemotherapy
- Radiotherapy
- Bisphosphonates
If a patient has managed periodontal disease, how long should you wait before making an orthodontic referral?
At least 6 months in order to enable healing prior to ortho treatment.
Why may patients with stable periodontitis not be suitable for ortho tx?
Teeth may not be suitable to provide anchorage for orthodontic tooth movement.
May need implants to provide some anchorage.
How can orthodontics affect the periodontium?
- Plaque control is difficult due to presence of brackets, wires or other aligners
- Perio pt may suffer further loss of attachment particularly if plaque control is poor
- A gingivally health pt may develop gingivitis, pocketing and even periodontitis
- Can cause complications with gingival position, black triangles, gaps and crowding
Must review pt regularly during their orthodontic tx and monitor periodontal measurements including pocket depths.
Will orthodontics always affect the gingivae?
No, if plaque control is good the periodontium should not be affected.
However, there are other factors which can increase chances of ortho affecting the periodontium.
What factors increase the chances of ortho affecting the periodontium?
- Thin gingival biotype (risk of localised recession)
- Limited attached keratinised mucosa causing bony dehiscence or recession
- Movement into areas where teeth have been extracted (i.e. areas of bone loss) can cause dehiscences
- Closing spaces can cause gingival recession
- Bodily movement or extreme rotation are more likely to cause recession than minimal rotation
What is the Dahl technique?
A similar specialist technique to ortho extrusion, used in teeth with tooth wear with limited space for restorations.
Alters the occlusion on several teeth and requires specialist planning with a prosthodontist.
“Relative axial tooth movement that is observed when a localised appliance or localised restorations are placed in supra-occlusion and the occlusion re-establishes full arch contacts over a period of time”
What are the possible effects of uprighting molars on periodontal tissues?
- The teeth may tilt if there is spacing or loss of adjacent teeth, uprighting corrects this but prosthodontic involvement may be needed i.e. bridge fitting to keep the tooth in correct position
Why is intrusion used in ortho and how can this type of movement affect periodontal tissues?
- Used to correct gingival margin position or sometimes to manage bone defects
- Can use this movement type even if the pt has stable perio, however there is an increased risk of root resorption
What is one major complaint patients have following tx for periodontitis?
- Outcome is often unaesthetic
- E.g. in these images we can see that the pt now has stable perio, but as a result has severe interdental recession and gaps which would be challenging to manage with orthodontics alone
To manage this case aesthetically, we will need a combination of specialist, orthodontic, surgical and prosthodontic care.
